Applying the global positioning system and google earth to evaluate the accessibility of birth services for pregnant women in northern Malawi.

INTRODUCTION: The objective of this study was to validate the combined use of the Global Positioning System (GPS) and Google Earth for measuring the accessibility of health care facilities for pregnant women in northern Malawi. METHODS: We used GPS and Google Earth to identify 5 major health care facilities in Mzuzu (Malawi) and the homes of 79 traditional birth attendants (TBAs). The distance and time required for each TBA to reach the nearest health care facility were measured by both GPS and by self-report of the TBAs. A convenience sample of 1138 pregnant women was interviewed about their choices of birth sites for current and previous pregnancies and the time and cost required to access health care facilities. RESULTS: The correlation coefficient between the objective measurements by GPS and subjective reports by TBAs for time required from their homes to health care facilities was 0.654 (P < .001). Among pregnant women, 45.6% reported that they could reach a health care facility within 2 hours; 23.8% reported paying more than $1 for transportation to health care facilities. For the current study, 82.6% of women intended to give birth at a health care facility. However, only 48.7% of women actually gave birth in a health care facility in a previous pregnancy, and 32.6% were assisted by TBAs. DISCUSSION: Combined GPS and Google Earth can be useful in the evaluation of accessibility of health care facilities, especially for emergency obstetric care.

The effectiveness of continuing training for traditional birth attendants on their reproductive health-care knowledge and performance.

OBJECTIVE: to evaluate the effectiveness of continuing training for traditional birth attendants (TBAs) on their reproductive knowledge and performance. SETTING: Mzuzu Central Hospital in the northern region of Malawi. PARTICIPANTS AND ANALYSIS: a total of 81 TBAs trained during 2004 and 2006 in Mzuzu, Malawi received continuing training courses. Their reproductive knowledge was assessed by a structured questionnaire during 2004 and 2007. A multivariate generalised estimating equation (GEE) model was constructed to determine the associations between their reproductive knowledge scores and age, years of education, time since the last training course, test frequency and number of babies delivered. FINDINGS: from July 2004 to June 2007, a total of 1984 pregnant women visited these trained TBAs. A total of 79 (4.0%) mothers were referred to health facilities before the birth due to first-born or difficult pregnancies. No maternal deaths occurred among the remaining mothers. There were 26 deaths among 1905 newborn babies, giving a perinatal mortality rate of 13.6 per 1000 live births. The GEE model demonstrated that knowledge scores of TBAs were significantly higher for TBAs under the age of 45 years, TBAs with more than five years of education, TBAs who had taken a training course within one year, and TBAs with a higher test frequency. CONCLUSION AND IMPLICATIONS FOR PRACTICE: continuing training courses are effective to maintain the reproductive knowledge and performance of trained TBAs. It is recommended that continuing training should be offered regularly, at least annually.

Developing national treatment policy for falciparum malaria in Africa: Malawi experience.

The emergence and spread across sub-Saharan Africa of Plasmodium falciparum resistant to the inexpensive antimalarials chloroquine and sulfadoxine-pyrimethamine has worsened the health and hampered the socio-economic development of affected countries, a situation that calls for urgent review of malaria treatment policies in these countries. The Roll Back Malaria (RBM) initiative promotes strong partnerships for implementing effective malaria control measures. The development of clear policies to guide such implementation at country level offers a way of assessing the achievement of set milestones in this collaborative venture. In this article we describe the policy development process for the treatment of falciparum malaria in Africa, based on experience in Malawi, where the first-line drug treatment was recently changed from sulfadoxine-pyrimethamine to an artemisinin combination therapy.

Shortfalls identified in the management of tuberculosis for Mozambican patients obtaining health care services in Malawi.

We report findings of a pilot qualitative study in which we aimed to determine management gaps among TB patients from Mozambique obtaining health care services in Malawi. The study was conducted between April and May 2002 involved twelve health workers and 4 Mozambican patients. Semi-structured questionnaires were used and responses were followed up with in-depth interviews. Several areas of management gaps were identified. These included; language barrier if patients are formally referred with documents in Portuguese; lack of follow-up system in case of patients defaulting; no structured contact-tracing possibilities and no initiation of Isoniazid prophylaxis in the case of children living in households with a sputum smear positive adult case. We conclude that logistical management gaps exist in the management of TB patients from Mozambique obtaining care in Malawian health care facilities.